Acute Medicine | Palliative care | Assessment and management of agitation and delirium

Assessment and management of agitation and delirium
Session overview
Description
This session provides a framework for recognising and managing agitation in patients with advanced illness.

It was reviewed by Felicity Wood and Sarah Hanrott and last updated in May 2023.

Learning objectives
By the end of this session you will be able to:

• give a working definition of agitation associated with advanced disease
• describe the common pattern of symptoms associated with agitation, recognising their variability
• outline the core steps involved in assessment, recognising the main medical, physical and psychological causes of agitation
• outline examples of general and pharmacological management that can be offered for symptom control of agitation, in addition to addressing reversible causes where appropriate

Agitation is an unpleasant state of extreme arousal, tension and irritability. It can come on suddenly or gradually, and often comes and goes. It is distressing for the patient, their family and staff working with them.

More prolonged agitation accompanied by altered consciousness or confusion is often called delirium. Delirium is a poor prognostic sign in patients at any stage of the end of life care pathway.

This session will discuss recognition of agitation/confusion and the key factors to be considered as part of the assessment. It will explain the drug management to control symptoms and relieve distress, as well as more general measures to support the patient.